M 936Cn Form PDF Details

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QuestionAnswer
Form NameM 936Cn Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespa notification dot, construction notification, construction notification template, pa form m 936cn 6 12

Form Preview Example

M-936CN (6-12)

www.dot.state.pa.us

construction notification

application

Original Application ID#:

Current Application ID#:

The motor carrier who provided you with this document has applied to PennDOT to move an oversize and/or overweight vehicle or combination and nondivisible load on a State Route that is currently under construction by your company.

PennDOT staff will thoroughly review the motor carrier’s application and proposed routes. The motor carrier is required to coordinate any movement through construction project areas and to verify the construction contractor’s approval for the motor carrier to travel through the construction project area on the specified date(s) at the permitted sizes and weights.

Motor Carrier inforMation: (Please Print)

Motor Carrier’s Name: __________________________________________________________________________________

Address: ____________________________________________________________________________________________

City: _____________________________________________ State: __________ Zip Code: ________________________

Contact Person: _________________________________________________

Phone Number: ________________________________ Fax Number: ________________________________________

Email Address: _________________________________________________

Insurance Company: _____________________________________ Policy # ______________________________________

LoCation of ConStrUCtion: (Please Print)

Weight and Dimensions of Vehicle(s) and Load:

Gross Weight: _____________________ LBS.

Overall Width: __________FT. ________ IN.

Overall Length: __________FT. ________ IN.

Overall Height: __________FT. ________ IN.

Projected number of moves: _______ Anticipated move dates: FROM: _______________ TO: _______________

Affected Route(s): ______________________________________ Affected County(ies): _____________________________

ContraCtor inforMation: (Please Print)

The above motor carrier may travel through our construction project on the above listed route(s) and date(s). The motor carrier is responsible for any and all injuries or damages in the construction project area arising from the movement(s).

Special Conditions: The motor carrier must notify this contractor at least 24 hours before each movement.

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Contractor’s Name: ______________________________________________________________

Contact Person: __________________________________________________________

Phone Number: _______________________________ Fax Number: __________________________________________

Email Address: ________________________________________________

Contact Person Signature: ________________________________________ Date: ____________________________

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In an effort to complete this PDF document, make certain you enter the information you need in every single area:

1. It's important to fill out the construction notification accurately, therefore take care while working with the sections comprising all these blank fields:

How you can prepare penndot m936cn step 1

2. Your next stage is to fill out the next few blank fields: Insurance Company Policy, Weight and Dimensions of Vehicles, LoCation of ConStrUCtion Please, Gross Weight LBS Overall Length, Overall Width FT IN Overall, Projected number of moves, Affected Routes Affected, ContraCtor inforMation Please Print, The above motor carrier may travel, is responsible for any and all, Special Conditions The motor, and Contractors Name.

penndot m936cn writing process detailed (step 2)

3. This next segment should also be relatively straightforward, Contractors Name, Contact Person, Phone Number Fax Number, Email Address, and Contact Person Signature Date - all these form fields has to be filled in here.

Completing section 3 of penndot m936cn

It is easy to make errors while filling in the Contractors Name, consequently make sure you reread it prior to when you submit it.

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